Doing More With Less: Healthcare in Remote Southern Bolivia
Visit Tarija, a tranquil city in southern Bolivia of about 200,000 people. This picturesque region is known as the “Bolivian Andalucia” for its vineyards and Spanish cultural influence. Tarija offers universal health insurance, which can create high demand for services and strains on the system due to lack of personnel and equipment. Understand cultural and socioeconomic barriers patients face in accessing healthcare services and witness treatments for pathologies not commonly seen in North America, including parasitosis, tuberculosis, and Chagas.
Learn from health professionals and become immersed in Tarija’s healthcare system, including community clinics, secondary and tertiary level hospitals, and a leading clinic for the treatment of Chagas Disease. Chagas, the “new AIDS of the Americas,” currently infects 1.8 million people in Bolivia alone, primarily in rural areas. Shadow healthcare professionals as they undertake patient consultations, laboratory analysis, and prevention efforts in surrounding communities, while learning from local experts about the latest developments in Chagas research. In addition to clinical rotations, participants can choose to meet with the staff of a local children’s shelter providing vocational training and social services for underserved youth to learn more about the socio-economic determinants of children health.
Become immersed in Bolivian culture and language through conversational and medical Spanish classes while living with a local family in Tarija. CFHI participants may also organize weekend trips to nearby destinations including wineries and waterfalls in Coimata.
Clinical Rotation & Public Health Placements
Regional Teaching Hospital- Located in the central part of the city, this tertiary hospital accepts students from universities throughout Bolivia including medical interns, nursing students, and dentistry students. It offers services to the entire state, including people with limited resources and indigenous groups. Rotate with local physicians through specialties including pediatrics, surgery, cardiology and internal medicine. This hospital has 250 beds and inpatient wards in basic specialties, as well as a neonatal intensive care unit. There is a high prevalence of Chagas in this region and cases are treated at this facility.
Primary Healthcare Centers- Located in every neighborhood, these clinics accept all patients regardless of ability to pay. Here, physicians and nurses provide health education, family planning, disease detection, and basic primary care services including vaccinations and well-child checkups. Join local health professionals and learn about common diseases, seeing firsthand how poverty affects families’ access to health care. Rotate at one of two clinics in the center of town or travel 12 miles to a rural facility and conduct outreach and home visits within surrounding communities.
Chagas Clinic- This clinic is small, but serves roughly 30 patients per day. It houses 3 consultation rooms, a laboratory, and an administrative office. Rotate through all 3 areas over the course of 4 days or more if requested. Learn the symptoms and progression of Chagas disease, observe the diagnosis and treatment, and identify the parasite under a microscope. This facility also conducts research on new medications and treatments.
Tertiary Government Hospital- This hospital has 200 inpatient beds and an ambulatory care ward with outpatient offices. Learn from healthcare professionals through rotations in internal medicine, ob/gyn, surgery, pediatrics, and oncology. This teaching hospital attracts local medical and nursing students, as well as residents specializing in pediatrics and internal medicine. This facility provides high quality care to working, middle class and retired populations with government health insurance.
Center for Children & Adolescents (optional)- This NGO provides underserved youth with meals, counseling, and job training in cooking, gardening, and electrical repair. The center also operates a bakery to generate income. Previous CFHI participants have volunteered teaching English and tutoring in reading and writing or co-organizing art, music or sport classes with the NGO staff depending on interests and personal skills.
CFHI is considered a global health ethics leader therefore CFHI programs uphold strict standards and comply with all local laws regarding student involvement in health settings. Your experience on the program depends on your previous clinical training (if applicable), Spanish level, and the relationship you build with your supervising preceptor. Above all, YOU are the most important factor in making the CFHI experience as fulfilling as possible by being respectful, culturally humble, inquisitive, and open to the wide variety of learning experiences which you will encounter.
Bolivia is a geographically diverse country home to both the Amazon jungle and Andes mountain range. This land-locked country in the heart of South America was formerly part of the Inca Empire and borders Brazil, Peru, Chile, Paraguay and Uruguay. It is one of the poorest and most underdeveloped countries in Latin America.
This program is based in Tarija, a modern city in southern Bolivia known for its wineries, pleasant climate, and relaxed atmosphere. Residents identify more with the State of Tarija itself than the rest of Bolivia. Tarijeños have their own unique customs and way of life, influenced by Spanish and various indigenous cultures. There are many festivals to enjoy throughout the year, including the Festival of Wine held in March and the Fiesta de San Roque in September, with traditional musical presentations and a colorful procession of Los Chunchos.
Things To Do
CFHI participants have free time during most evenings and weekends and may choose to organize weekend trips to nearby destinations and take part in cultural activities offered within Tarija itself.
Restaurants, shops, and palm trees line Tarija’s main plaza. When in Tarija, do as the locals do—grab a pastry while shopping for local handicrafts or simply enjoy the scenery and Mediterranean climate. Tour Casa Dorada or The Gilded House dating back to 1930. On the weekend, visit surrounding wineries in El Valle de la Concepción and sample the popular local spirit, singani, produced exclusively in this region.
Accommodation & Homestay
Participants stay with homestay families, chosen and screened by the CFHI Local Coordinator. Homestay families live in middle class neighborhoods in close proximity to one another in the center of town. There are many shops, restaurants and cafes in the area. In some cases CFHI participants may be housed with others in the same homestay, but will have their own room.
Homestays provide a unique opportunity to learn about local culture and practice Spanish skills on a daily basis in an informal setting. Accommodation includes two meals a day. At the welcome orientation, participants will be instructed on recommended transportation from homestays to clinical rotations and getting around the city.
Eligibility: Who Can Apply?
This CFHI program is ideal for students who have a foundation in Spanish and have an interest in health and medicine in small town and rural settings. Non-students are also eligible. The program offers an overview of primary and secondary level care through visits within a hospital and primary care clinics, as well as Spanish language classes with an emphasis on medical Spanish. To confirm whether you're eligible to apply, please read CFHI's general eligibility requirements.
Minimum Language Required: Beginner 1 Spanish or Above
Beginner 1 Spanish: “I can speak a little and understand at times if people speak slowly and clearly.”
- I can understand and use familiar everyday expressions and simple phrases to get across basic needs.
- I can introduce others and myself. I can ask and answer questions for example where I live, people I know and things I have.
Leading this program on-site are our on-site partners (see Local Team tab), all of whom share Spanish as their native language, but may speak English as well. To provide authentic learning experiences translators are not provided. Daily interactions will be in Spanish, but CFHI’s local team is able to support and help you through your experience.
All CFHI participants applying to programs in Latin America will evaluate their Spanish language skills as part of their application. This information will then be shared with the on-site partners. Most important is your general ability to communicate verbally with those around you and to be proactive in speaking Spanish, versus accuracy with grammatical tenses. All CFHI Latin America programs include Spanish language instruction on-site.
Not sure about your Spanish level? View a full list of CFHI’s language levels for all Latin America programs on our Spanish Level Guidelines page.
Participants should arrive in Tarija on the program start date and will be picked up from the airport by a CFHI representative and taken to their homestay. A welcome orientation will take place the Sunday or Monday after arrival.
U.S. citizens must obtain a tourist visa for Bolivia. This can be done upon arrival at the airport. More information on travel and logistics will be provided by CFHI after acceptance into the program.
- Guidance from CFHI staff in San Francisco before departure
- Program-specific materials with information on making travel arrangements, visa requirements, recommended immunizations, etc.
- Airport pick-up upon arrival and transportation to homestay in Tarija with local CFHI representative
- Welcome orientation with other participants covering safety, transportation, and other logistics
- Spanish Classes: 30 hours/month of Spanish classes with a private tutor
- CFHI Local Team: providing instruction, logistical support, and 24/7 emergency response
- Weekly meetings and lectures on local healthcare system and socio-economic determinants of health
- Placement and coordination of clinical/public health activities
- Accommodation and two meals a day
- Local cell phone
- International emergency medical and evacuation insurance
- Access to CFHI alumni-only LinkedIn group featuring news and career opportunities related to Global Health
- CFHI alumni newsletter highlighting events, resources, and ways to stay involved
Uniquely CFHI, 50% or more of student program fees go directly to the communities they will be visiting, benefiting the local economy at large and specifically underserved health systems. Read more
Meet the Local Team
Dr. Karina Gamarra Hoyos- CFHI Tarija Medical Director: The role of CFHI Medical Director is to arrange clinical and public health placements, supervise participant experiences at these sites, provide weekly lectures, and assist in medical issues experienced by participants. Dr. Gamarra is the expert on socioeconomic determinants of health in the region and healthcare delivery strategies in low-resource settings.
Dr. Karina Gamarra Hoyos has been working with CFHI since 2009. She completed her MD at San Francisco Xavier de Chuquisaca in Sucre, Bolivia and her MPH at Universidad Autónoma Juan Misael Saracho in Havana, Cuba, specializing in Epidemiology. Dr. Gamarra also has extensive research experience on Chagas disease and currently manages her own health consulting firm, designing and implementing health programs in the region.
Mr. Fabricio Uribe Itturicha- CFHI Tarija Local Coordinator: The role of the CFHI Local Coordinator is to organize housing, transportation, orientation and weekly meetings. Fabricio is a great resource for any questions related to navigating the program locale, cultural norms and tips on planning weekend travel.
Fabricio has been involved with CFHI since 2009. He has a background in Agricultural Engineering. He has international experience, having participated in cultural exchange programs to the US and Germany as a college student. Currently, he is the Regional Manager of a construction company in Tarija.
What Alumni Say
“I came to Bolivia to learn about the cultural aspects of a developing country and how they influence healthcare. The combination of participating in the La Paz and Tarija programs was absolutely the best part of my trip. Getting to see two cities in the same country with such diverse types of people, climate, and medical problems was beyond fascinating. I feel that I have left my two programs..." Read More on Cory's blog.
-- Cory Kosche, Pre-med Senior (Alumna, March & April 2013)